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Dunkirk Dental
Dunkirk Dental
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Patient Information

Your First Visit

Your First Visit

Your First Visit

Prior to meeting with the dentist, at your first visit, complete the new patient forms, see Forms section below. 


You may print and complete before you arrive at our office OR arrive 15 minutes prior to your appointment, and we will provide you the forms to complete. 


If you have dental insurance, bring your dental insurance card. 

Scheduling

Your First Visit

Your First Visit

Call (763) 420-9876 to schedule your appointment.


A minimum 48-hour notice is expected when cancelling or rescheduling to avoid a missed/ broken appointment charge of $50.00.


For established patients, a doctor is on call for after hour emergencies.  Contact information for the doctor on call is always available on our voice mail. 



Insurance

Your First Visit

Financial Policy

Dunkirk Dental is an in-network provider for many group plans* of: 

  • Cigna Dental
  • Delta Dental 
  • Health  Partners Dental 
  • Medica Dental
  • Premier Dental Group

Dunkirk Dental is not a provider for State MA Programs, including Civic Smiles, and UCare. 


*Verify your insurance eligibility and benefits with your insurance carrier. 

Financial Policy

Uninsured Savings Program

Financial Policy

Payment is due at the time service is provided. 


You are fully responsible for all fees charged by this office regardless of your insurance coverage.

  • If you have insurance, we collect only the patient responsibility portion.      

We Accept: Cash, Check, and Credit Card

Visa | MasterCard | Discover |American Express.


A 1.5% (18% annually) finance charge is applied monthly on all accounts over 60 days.     


Uninsured Savings Program

Uninsured Savings Program

Uninsured Savings Program

To qualify for Dunkirk Dental Uninsured Savings Program, you must meet the following criteria: 

  • No dental insurance or dental benefits available 
  • Account balance paid in full at time of service. 

Discount: 

  • 10% discount if paid by cash or check. 


Forms | Resources

Uninsured Savings Program

Uninsured Savings Program

New Patient Forms:

  • Patient Information Form 
  • Health History Questionnaire
  • Notice of Privacy Practices (form to sign) 
  • Notice of Privacy Practices 

X-rays transfer form:

  • Radiograph Transfer Request Form

COVID Forms:

  • COVID Screening Form
  • COVID Notice & Acknowledgement of Risk form

Website Accessibility

The highest compliment our patients can give is the referral of their friends and family.

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